Can prehospital high-dose glucocorticoids impact hemodynamics in patients resuscitated from out-of-hospital cardiac arrest?

Recently published study is a sub-study of the STEROHCA trial and focuses on assessing the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose out-of-hospital cardiac arrest (OHCA) patients. The aim was to evaluate the association between inflammatory markers, hemodynamic instability, organ dysfunction, and the need for vasopressor support. The study included patients who remained comatose at admission and survived until intensive care unit (ICU) admission. The primary outcome was the cumulated norepinephrine use from ICU admission until 48 h reported as mcg/kg/min.

The STEROHCA trial was a phase 2 randomised study that compared the effects of a single prehospital injection of methylprednisolone 250 mg with a placebo given shortly after resuscitated out-of-hospital cardiac arrest. This sub-study included patients who were unconscious at arrival and survived until they were admitted to the intensive care unit (ICU). The main result was the total amount of norepinephrine used from ICU admission to 48 hours, recorded in mcg/kg/min. Secondary outcomes were assessing hemodynamic state using mean arterial pressure (MAP), heart rate, vasoactive-inotropic score (VIS), and the VIS/MAP-ratio, as well as evaluating cardiac function by pulmonary artery catheter measures. Linear mixed-model analyses were used to assess the mean differences between treatment groups at all follow-up dates.

Results of Glucocorticoid Treatment

The results of the study indicated that prehospital treatment with high-dose glucocorticoid was associated with reduced norepinephrine use in resuscitated OHCA patients. Specifically, from the time of ICU admission up to 48 h post-admission, patients in the glucocorticoid group cumulated a lower norepinephrine use. Additionally, the glucocorticoid group showed a higher mean arterial pressure (MAP) after 12–24 h post-admission, with no major differences in heart rate. The differences between the treatment groups were also present 30–48 h post-admission but to a smaller extent. No differences were found in pulmonary artery catheter measurements between groups.

Implications and Future Research

The findings suggest that glucocorticoid treatment in the prehospital setting may lead to reduced norepinephrine use and improved hemodynamic stability in resuscitated OHCA patients. However, further research is needed to determine the long-term effects and clinical outcomes of high-dose glucocorticoid treatment in this patient population. This study provides valuable insights into the potential impacts of glucocorticoid treatment on hemodynamics in resuscitated OHCA patients.

Reference -

Obling, L.E.R., Beske, R.P., Meyer, M.A.S. et al. Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial. Crit Care 28, 28 (2024). https://doi.org/10.1186/s13054-024-04808-3.